BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

PURPOSE: To determine the efficacy of CarnitilR (acetylcarnitine, Hanmi, Korea) therapy in idiopathic oligoasthenospermic men. MATERIALS AND METHODS: Forty-four subfertile men with abnormal semen parameters were treated between March, 2003 and March, 2004 with 3 g of CarnitilR daily for 3 months. Changes in semen parameters were evaluated 3 months after this therapy. RESULTS: The mean age was 34.2 years and the mean follow-up duration was 3.7 months. In asthenospemic patients (n=28), semen analysis before and after CarnitilR treatment showed an increase in volume (2.64+/-1.65 ml vs. 3.10+/-1.60 ml), motility (35.1+/-17.7% vs. 45.9+/-20.4%) and viability (51.4+/-20.3% vs. 59.3+/-13.6%) respectively. In oligoasthenospermic patients (n=16), semen analysis before and after CarnitilR treatment showed an increase in sperm count (10.7+/-54.4 million/ml vs. 38.4+/-32.5 million/ml) respectively. CONCLUSIONS: These results suggested that in idiopathic oligoasthenospermic men the empirical medical therapy with acetylcarnitine may be considered as primary treatment.
Acetylcarnitine* ; Carnitine ; Follow-Up Studies ; Humans ; Infertility, Male ; Male ; Semen ; Semen Analysis ; Sperm Count

PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

PURPOSE: Retrieved sperm or testicular tissues are sometimes cryopreserved at the time of a vasovasostomy or vasoepididymostomy. It is possible to use cryopreserved sperm with intracytoplasmic sperm injection(ICSI) in the case of failure of pregnancy or surgical correction. The need for sperm cryopreservation at the time of a vasovasostomy or vasoepididymostomy was evaluated. MATERIALS AND METHODS: A total of 61 patients underwent a vasovasostomy and 42 underwent a vasoepididymostomy, performed by one urologist(J.T.S), between May 1994 and April 1999. Follow up data were available for 42 and 32 cases of vasovasostomy and vasoepididymostomy, respectively. Sperm cryopreservation was carried out at the time of the vasovasostomy in 6 cases(6/42) and the vasoepididymostomy in 18(18/32). RESULTS: The overall patency rates were 92.9(39/42) and 37.5%(12/32) for the vasovasostomy and vasoepididymostomy, respectively. The pregnancy rates in the case of successful surgical correction were 56.4%(22/39) and 41.6%(5/12) for the vasovasostomy vasoepididymostomy, respectively. Only in 8 cases(8/18) were the cryopreservated sperm used after a failed vasoepididymostomy. CONCLUSIONS: A vasovasostomy exhibited a higher patency and pregnancy rates than a vasoepididymostomy. Routine sperm cryopreservation in men undergoing vasovasostomy is not recommended. Sperm cryopreservation during an operation is recommended for surgical and pregnancy failures, in men undergoing vasoepididymostomy. Intraoperative sperm cryopreservation in men undergoing vasoepididymostomy will maximize the postoperative fertility options.
Cryopreservation* ; Fertility ; Follow-Up Studies ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Spermatozoa* ; Vasovasostomy*

The surgical construction of vagina could certainlty be done by skin grafting or flaps, but it involves hospitalization, discomfort,scarring of donor area and vaginal tract, hygiene problem. The tissues of the vagina are soft and distensible and it is reasonable to assume that these same tissues could be stretched, elongated or dilated with gradual external pressure. So, we performed the expansion of vaginal lining by self designed set of graduated dilators. The patients was a 27-years-old female whose chief complaint is amenorrhea and incapability to engage in sexual intercourse. On physical examination, this patients had a feminine figure with a normal vulva but only a vaginal dimple was observed. The patient was educated to carry out the mechanical dilation of this dimply by pressure 15 minutes twice a day. In the evening, with insertion of a dilator, the patient was asked to sit on a bicycle chair for 10 minutes. After 8 weeks, the overall outcome of vaginoplasty was successful. The vaginal tract was 8 cm in length and the largest vaginal speculum could be passed into vagina. The patient was able to engage in sexual intercourse without lubrication. The progressive dilatation of vaginal lining is non-invasive and probably the simplest way to treat the patients with congential vaginal atresia. So we recommend this method as the first treatment strategy before surgery.
Amenorrhea ; Coitus ; Dilatation* ; Female ; Hospitalization ; Humans ; Hygiene ; Lubrication ; Physical Examination ; Skin Transplantation ; Surgical Instruments ; Tissue Donors ; Vagina ; Vulva

Objectives: ：The purpose of this study is to evaluate the effect of a school-based social skills training program on the social decision-making of children and adolescents and to assess plan for effective school-based mental health services. Methods: ：It was performed school-based social skills training (n=46, 7 sessions) in elementary and middle school students. Evaluations were conducted before and after the application of the program using a ultimatum game and dictator game, in order to identify changes. Results: ：Before social skills training program (SSTP), the younger students showed higher acceptance rates of unfair offers than the older students in ultimatum game (UG) [at 9:1 offers 0.79±0.08>0.55±0.12 (p=0.001); at 8:2 offers 0.81±0.11>0.59±0.11 (p=0.001)]. the rejection rates of unfair offers in UG significantly increased after SSTP[at 9:1 offers 0.64±0.19→0.43±0.18 (p=0.001) ; at 8:2 offers 0.67±0.16→0.54±0.16 (p=0.046) ; at 7:3 offers 0.83± 0.20→0.65±0.12 (p=0.001)]. the rejection rates of unfair offers in UG significantly increased at happy and at neutral facial expression of proposers after SSTP[happy facial expression condition, at 9:1 offers 0.89±0.12→0.68±0.19 (p=0.001) ; at 8:2 offers 0.82±0.19→0.72±0.14 (p=0.001) ; at 7:3 offers 0.99±0.07→0.92±0.17 (p=0.040] [neutral facial expression condition, at 9:1 offers 0.71±0.20→0.54±0.13 (p=0.001) ; at 8:2 offers 0.61±0.18→0.52±0.06 (p=0.001) ; at 7:3 offers 0.91±0.13→0.83±0.12 (p=0.001)]. the amount of money offered as a proposer in dictator game significantly increased after SSTP [3989.1±1952.3→4742.5±371.1, (p=0.012)]. Conclusion ：The social skills training program positively influences the social decision-making. The school-based social skills training program can be expected to have positive results in school-based mental health services. Future investigation is needed to validate the long term effects of this program.

Neurofibromatosis type1(von Recklinghausen's disease) is characterized by multiple skin tumors and abnormal cutaneous pigmentation(cafe au lait spots). Unlikely the solitary neurofibroma, those encountered in von Recklinghausen's disease may cause significant morbidity. The vasculopathy, although poorly recognized manifestation of von Recklinghausen's neurofibromatosis is a major cause of fatal cases. One of its most dramatic presentation is the spontaneous hemothorax. We report a case of Von Recklinghausen's disease with multiple neurofibromatosis accompanying intrathoracic hemorrhage due to vascular rupture, which is the first legal autopsy case in korea.
Autopsy ; Death, Sudden* ; Hemorrhage ; Hemothorax ; Humans ; Korea ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Rupture ; Skin

PURPOSE: To correlate the preoperative staging of gastric adenocarcinoma using two-phase spiral CT withpathologic staging. MATERIALS AND METHODS: One hundred and eighty patients with gastric cancers confirmed duringsurgery underwent two-phase spiral CT, and were evaluated retrospectively. CT scans were obtained in the proneposition after ingestion of water. Scans were performed 35 and 80 seconds after the start of infusion of 120mL ofnon-ionic contrast material with the speed of 3mL/sec. Five mm collimation, 7mm/sec table feed and 5mmreconstruction interval were used. T- and N-stage were determined using spiral CT images, without knowledge of thepathologic results. Pathologic staging was later compared with CT staging. RESULTS: Pathologic T-stage was T1 in70 cases(38.9%), T2 in 33 (18.3%), T3 in 73 (40.6%), and T4 in 4 (2.2%). Type-I or IIa elevated lesions accountedfor 10 of 70 T1 cases(14.3%) and flat or depressed lesions(type IIb, IIc, or III) for 60 (85.7%). PathologicN-stage was N0 in 85 cases(47.2%), N1 in 42 (23.3%), N2 in 31 (17.2%), and N3 in 22 (12.2%). The detection rate ofearly gastric cancer using two-phase spiral CT was 100.0%(10 of 10 cases) among elevated lesions and 78.3%(47 of60 cases) among flat or depressed lesions. With regard to T-stage, there was good correlation between CT image andpathology in 86 of 180 cases (47.8%). Overstaging occurred in 23.3%(42 of 180 cases) and understaging in 28.9%(52of 180 cases). With regard to N-stage, good correlation between CT image and pathology was noted in 94 of 180cases (52.2%). The rate of understaging(31.7%, 57 of 180 cases) was higher than that of overstaging(16.1%, 29 of180 cases)(p<0.001). CONCLUSION: The detection rate of early gastric cancer using two-phase spiral CT was 81.4%,and there was no significant difference in detectability between elevated and depressed lesions. Two-phase spiralCT for determing the T- and N-stage of gastric cancer was not effective ; it was accurate in abont 50% of casesunderstaging tended to occur.
Adenocarcinoma* ; Eating ; Humans ; Pathology ; Retrospective Studies ; Stomach Neoplasms ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Water

No abstract available.
Basal Ganglia Diseases/diagnostic imaging/drug therapy/*etiology ; Calcinosis/diagnostic imaging/drug therapy/*etiology ; Calcium/therapeutic use ; Dietary Supplements ; Female ; Humans ; Hypoparathyroidism/*complications/diagnosis/drug therapy ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome ; Vitamin D/therapeutic use

PURPOSE: To evaluate the degree of mucosal coating on double contrast barium enema (DCBE) using barium suspension made with distilled water or normal saline. MATERIALS AND METHODS: Between June 1 and July 30, 1996, fifty-four patients prospectively underwent DCBE using 83% w/v(weight-to-volme) of barium suspension (room temperature, 24 degrees), which was made with 1,200 mL of distilled water (Group 1 ; 29 cases) and normal saline (Group 2 ; 25 cases) per 1 Kg of Solotopr (Taejoon Pharmacy, Seoul, Korea). Bowel preparation and examination methods were the same in both groups, and four projections (erect view, supine view, both decubitus views) were taken. The mucosal coating was graded as excellent, good, ordinary, or poor by three radiologists working independently, and scored from 3 to 0. Significance was analyzed by t-test. RESULTS: Mean grading scores 2.33+/-0.70 in group 1 and1.56+/-0.99 in group 2 (P < 0.003). CONCLUSION: When barium suspension made with distilled water was used, the degree of mucosal coating on DCBE was better than when the suspension was made with normal saline.
Barium* ; Enema* ; Humans ; Pharmacy ; Prospective Studies ; Seoul ; Water*